Morfology of the orofacial systém

Morfology of the orofacial systém

Anatomical remarks

Ivo Klepáček

The persecution of Christians began in Alexandria during the reign of the Emperor Philip. The first victim of the pagan mob was an old man named Metrius, who was tortured and then stoned to death. The second person who refused to worship their false idols was a Christian woman named Quinta. Her words infuriated the mob and she was scourged and stoned.

While most of the Christians were fleeing the city, abandoning all their worldly possessions, an old deaconess, Apollonia, was seized. The crowds beat her, knocking out all of her teeth. Then they lit a large fire and threatened to throw her in it if she did not curse her God. She begged them to wait a moment, acting as if she was considering their requests. Instead, she jumped willingly into the flames and so suffered martyrdom.

Skeleton of the face, thickened and weakened skull areas. Formation of jaws and dental arches.

Anatomical base of clefts of face and palate.

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rovina okluze occlusal plane protetická rovina Camper plane vodorovná rovina x

horizontal plane

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areae

regiones intermingling together

better

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30 yr man

CBCT 90300

3D visual methods Skull with cavities tendinous

insertions; ligaments projection of the nerves and vessels;

their arrangement

Topographic relation

between structures

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Face: What can be focused on ?

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Rysy obličeje - vztah mezi tvrdými a měkkými tkáněmi Face features - relation between soft and hard tissues

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A new classification of the nasolabial fold for use during facial reanimation surgery.

Bisarya K, Nduka C. Ann Royal Coll Surg 2009; 91: 535-536

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18 week

toddler

adultus

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Skin relief

is roughly determined by muscles and bones and formation of the subcutaneous tissue Kožní reliéf je přibližně

určen tvarem kostí a svalů a utvářením podkožní tkáně

Superficial spindle-like or strip-like or round Deep flat , partially overlapped by fibrous and fat tissue

Povrchové tvaru vřetene nebo pásku nebo kruhové Hluboké ploché částečně překryté vazivově-tukovou tkání

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Mimic muscles in head mm. faciales

Inervation from n.

facialis (nervus cranialis

septimus; VII.) muscles:

 Head vault

 Proper facial muscles

 Muscles around eye

 Muscles around nose Muscles around oral cavity

 Muscles around external ear

VII – FACIALIS Derivatives of the 2.

pharyngeal arch

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trigonum mortis Mimické svaly cévy obličeje

Mimic muscles face vessels

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H.Chang:Arterial anatomy of

subdermal plexus of the face. Keio J Med 50: (1)31-34

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Fibrous and fat Compartments

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Fasciocutaneous ligg. -

stippled areas Osteocutaneous ligg. - in black

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Zygomatico - cutaneous ligament

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ligamentum mandibulare

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Zony genové aktivity ve

tváři Expression of the main genetically active genes

in face

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• Adipocire

changes follow generally facial parts rich by fat

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Mrtvý ležící

Dead horizontal position

Živý stojící

Erectile position

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Transitional zone on lip Sulcus

buccolabialis Sulcus buccolabialis

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Prvé

pokusy First

attempts

Určení vrstev ? Determination of layers ?

After Jost , G, Levet, V.: Parotid fascia and Face lifting: A critical Evaluation of the SMAS concept.

Plastic and Reconstructive Surg, 74:42-51, 1983

modified

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Bryan Mendelson, and Chin- Ho Wong, Anatomy of facial ageing. Commentary 4.3e47- e51

Cutis

Tunica subcutanea

Fascia

temporoparietalis

Tunica areolaris

Fascia temporalis

Musculus

temporalis

Pericranium

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Orang-utan sumaterian

Pongo abelii

Fat in face is missing due to age gradually

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• The subcutaneous fat of the face is divided into numerous, anatomically separable clusters.

• Sulcus nasolabialis is a fine groove with well-defined anatomical borders.

• Face fat (not Bichat's pillow) is divided into three sections:

internal, middle and side.

• In the area of the forehead, three fat sections can be identified: the middle, side and intersecting sections between the middle and the lateral.

• Ophthalmic fat can be divided into three parts separated by septa.

• Grease in the chin is the lowest stored fat area of the face.

• Some structures between the skin and the periosteum are described as so-called & quot; retaining ligaments & quot;

and form a septum link between adjacent fatty regions.

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1. The eye brow falls and there is sub brow fat loss

2. Hollowness of the superior orbit 3. Prolapsed medial orbital fat pad 4. Looseness of lower eyelid

5. Prolapsed orbital fat pads inferiorly 6. Loss of mid face volume

7. Descent of mid face

↓8. Formation of tear trough secondary to loss of mid face volume and descent of mid face 9. Formation of nasolabial fold

10. Jowl line formation

11. Lips lose substantial volume and get thinner

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Platysma

size: 8x12 cm

origin: Fascia upper part of the mm. pectoralis major and

deltoideus

insertion: skin and subcutaneous layer of the lower face part.

! No direct connection with skull periosteum !

Vascular supply:

main source: a. submentalis small source: a. suprasternalis Nerve supply:

Motor: cervical branches of n. VII

Sensory:

n. cervicalis transversus

a. submentalis

a. suprasternalis

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SMAS SOOF

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The Eye Of Horus Resembles A Structure

Within The Brain

Larrabee WF, Makielski KH 1992

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A skin incision 1 cm away from the orbital rim.

Dissection down to the orbicularis oculi muscle

m. orbicularis oculi is separated from the orbital septum

Gross disection

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Muscles around nose



M. nasalis



from ventral maxilla surface to nose root; pars transversa (constrictor) et pars alaris (dilatator)



M. levator labii superioris alaquae nasi



Pars nasalis et pars labialis



M. depressor septi nasi



from ventral maxilla surface

to nose root and glabella



M. procerus



from nose root

to glabella

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lymph drainage of the external

nose, cheeks and upper lip

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M. levator labii superioris

 Below orbital margine

 To the skin following nasolabial groove

 M. zygomaticus minor

 Os zygomaticum

 To the distal area of the nasolabial groove

 M. zygomaticus major

 From the proc.

zygomaticus ossis temporalis

 To skin of the oral angle or to the

orbicularis oris muscle

M. levator labii superioris

 Pod margo infraorbitalis

 Do kůže u sulcus nasolabialis

 M. zygomaticus minor

 Os zygomaticum

 K distálnímu okraji sulcus nasolabialis

 M. zygomaticus major

 Od proc.

zygomaticus ossis temporalis

 Do kůže a

muskuloaponeuroti ckého tělesa u koutku ústního (modiolus)

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Face tvář

external malar pad

Vnější tvářové tukové těleso

malar fat expansion

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Duplicit form (zygomaticus duplex)

Rarely connected with s m. marginalis oculi

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Traction muscles: pars labialis m. levator labii superioris alaequae nasi, levator labii superioris, zygomaticus minor, depressor labii inferioris, pars labialis platysmatis

Perpendicularly connect lip (depression, protraction, eversion)

Muscles around corner: m. levator anguli oris, depressor anguli oris, levator labii

superioris, zygomaticus major, pars modiolaris platysmatis, buccinator, risorius, orbicularis oris, m. incisivus superior et m. incisivus inferior

Movement with mouth corner (elevation, depression, constriction and dilation rima oris)

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10 mm

5 mm

orbicularis oris, buccinator, levator anguli oris, depressor anguli oris, zygomaticus major, risorius, platysma, levator labii superioris

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intraoral dissection of the mimetic muscles using a fresh cadaver A: maxilla

B: mandible

BM; buccinator, ILI; incisivus labii inferioris,

ILS; incisivus labii superioris, LAO;

levator anguli oris, MF; mental foramen, OO; orbicularis oris, S; buccomandibular space, sMT; superior portion of the mentalis

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Buccal frenulum of the left

maxillaA: Before the removal of the mucosa

B: After the removal of the mucosa Black arrows: lateral border of the incisivus labii superioris (ILS),

white arrows: anterior border of the buccinator

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Face

internal fat pad - Bichatův polštář

Hluboké tukové těleso

Marie François Xavier Bichat 1771-1802

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Buccal fat pad

Pterygoid extension

Parotid duct

Facial nerve

Sublevator extension

Melolabial extension Buccal extension

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Motori innervation - nervus facialis

VII. CN nerve

sutura tympanomastoidea

“drop off point -

nejvíce vystupující bod“

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Vztah n. VII ke SMAS

CN VII relation to SMAS

kůže skin ---

musculus muscle *

kůže skin musculus muscle

---*---

kůže skin ---*^---

kost bone kůže skin

--- parotis * ^parotid

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n. VII. : tzv. „facial danger

zones“ -

Nerves and vessels are closer to face surface – they can be

wounded IK

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III.

2 cm

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V.

2.5 cm

Infraorb. For.

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VI.

3 cm

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VII.

6.5 cm

Ext. Jug. vein

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How to id

identify openings in the facial part of the skull

where nerves and arteries come to

periphery

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Petrovický a spol. 2001

Central and peripheral palsy of the CN VII.

Full line – nerve fibers are not affected Interrupted line – nerve fibers are

affected

Peripheral palsy affects full one half of face

Eylid is pushed down

Mouth corner is pushed down

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Pou ž itá literatura

R. Čihák:

Grada Publishing 2003

M. Dykes : Anatomy

2^th edition, Mosby 2002

S.Snell: Clinical anatomy for Medical Students 6^th edition, Lippincott, Williams & Wilkins

I.Klepáček, J.Mazánek et al.: Klinická anatomie ve stomatologii

Grada Publishing 2001

G.J.Tortora : Principles of Human Anatomy

4^th edition, Williams & Wilkins

K.L.Moore, A.F.Dalley: Clinically Oriented Anatomy

4^th edition, Williams & Wilkins

F.H.Netter:anatomický atlas člověka

Vlastní archív

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